Standards for Female and Male Sterilization Services - STATE ...

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20Standards for female and male Sterilization servicesEligibility Criteria for Male Surgical Sterilization procedures outlined by WHO (2004) servesas guidelines for case selection based on the clinical findings of the client (Annexure 7).However, the final selection of the case should be based on the case selection criteriaoutlined in 2.3 and guided by the medical eligibility criteria stated above.The operating surgeon must fill in the Medical Record and Checklist for Sterilizationplaced at Annexure 3 before initiating the surgery.2.4.3. Timing of Surgical ProcedureMale sterilization can be done at any convenient time on healthy clients.2.4.4. Informed Consent2.4.4.1. Consent for the sterilization operation should not be obtained under coercionor when the client is under sedation.2.4.4.2. Client must sign the consent form for sterilization before the surgery(Annexure 4).The consent of the spouse is not required for sterilization.2.4.5. Preoperative Instructionsa) The client should trim the pubic, scrotal, and perineal hair.b) The client should bathe and wear clean and loose clothes to the OT.c) The client should have a light meal on the morning of the surgery.d) The client should empty his bladder before entering the OT.2.4.6. Skin Preparation and Surgical Drapingi) The operative site should not be shaved. The hair can be trimmed, if not done earlier.ii) The operative site should be prepared immediately preoperatively with anantiseptic solution such as iodophor (Povidone iodine) or chlorhexidine gluconate(Cetavalone).iii) Iodophors require 1 to 2 minutes to work because there must be time for therelease of free iodine, which inactivates the micro-organisms.iv) Antiseptic solutions should be applied liberally at least two times on and aroundthe operative site, which should be thoroughly cleansed by gentle scrubbing.
Standards for female and male Sterilization services 21v)The antiseptic solution should be applied in a circular motion, beginning atthe site of incision and working out for several inches. This inhibits immediaterecontamination of the site with local skin bacteria.vi) Excess antiseptic solution should not be permitted to drip and gather beneath theclient’s body as this may cause irritation.vii) After preparing the operative site, the area should be covered with a sterile drape.2.4.7. Premedication/Anaesthesia/Analgesiaa) Premedication is optional. It should be administered only in the case of an anxiousclient in order to allay anxiety and to relax the scrotum. The drug of choice is tabletdiazepam 10 mg, which should be given one hour prior to surgery with a sip of water.b) Local anaesthesia is recommended for vasectomy procedures. The local anaestheticto be used is 1% lignocaine without adrenaline. The maximum dosage is 200 mg or 20ml of 1% lignocaine or 10 ml of 2% lignocaine (10 ml solution of 2%, to be dilutedwith an equal amount of distilled water).i) Adequate time must be allowed for the medication to be effective.ii) Communication must be maintained with the client throughout the operation.c)Monitoring: Vasectomy involves brief surgery. Constant communication with theclient will alert the surgeon to any adverse event. The staff should monitor the pulse,respiration, and blood pressure, and should respond to any emergency. A full recordof any adverse event must be kept.2.4.8. Surgical TechniquesI. Conventional Vasectomya) Incision: The vasectomy operation is to be performed either with two incisionslocated at the root of the scrotum on either side, or with one incision on themidline. The length of each incision should not be more than 2 cm. Smallerincisions will minimize the chances of complication.b) Site of vasectomy: The mid-scrotal part of the vas should be removed. Itmust not be cut close to the epididymis, over the convoluted part of the vasdeferens.c) Excision of vas: The vas must be separated from the tissues and excised in allcases. The portion excised should not be more than 1 cm in length. Removal of
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